One of the biggest and most dangerous myths around HIV is that the sanctity of marriage protects those in it from the virus. Certainly, if two people are tested, don't have HIV and don't go outside the marriage to sleep with others or inject drugs, marriage can provide a wonderful safeguard against diseases such as HIV. That's true for all committed partnerships, gay or straight.
But, the truth is that global infidelity rates are high. And in many places across the world, marriages don't reflect consensual love but instead represent business arrangements between families. Such marriages can often place a woman's health in a particularly vulnerable situation. In many cases, women are powerless to advocate for the safety of their own bodies. And if they try to negotiate for safer sex, for example, when they know their husbands are cheating, they put themselves at further risk for violence. Some may even have their own fidelity questioned.
In the developing world, men often must live far from their families to earn a living. And, while away, some engage in risky behaviors such as using drugs or paying for sex—and in the process contract HIV. Then, they bring the disease home and give it to their spouse.
When infidelity or injection drug use enters the equation, people in marriage can actually be at a greater risk, as they are not as likely to be using condoms or be aware they might be at risk. And for those aware of their spouse's extramarital habits or drug use, the very ring around their finger prevents them from protecting themselves from their husbands or from seeking safe havens outside the home.
Marital infidelity is also dangerous because it's something people don't like to discuss. Many people may suspect it's going on but are too afraid to face whatever pain the truth may bring. And so, denial leads people to not protect themselves.
When I got married (I am now divorced), a syphilis test was required. Given the low incidence of syphilis and the high rates of HIV in the United States at that time, I was surprised.
Perhaps HIV testing should be a mandatory requirement for marriage. After all, being aware of and caring for your spouse-to-be's health should be a prerequisite for signing up for a life together. Infidelity can still bring HIV into the marriage (by either the man or the woman), but an initial test could help raise awareness and educate both partners about potential risks.
As is so often the case, tracing the infection route of HIV illuminates the ills of society. The tough news is we have to address some really difficult challenges, like the global inequality of women and the lack of their empowerment, in order to best stop the spread of HIV.
This year marks the 30th anniversary of the first reported case of HIV. Let's hope that 2011 brings us closer to effective vaccines—and the cure. And that as we try to solve those scientific conundrums, we also resolve intermediate steps like developing effective microbicides—a very good solution for people who need to protect themselves against HIV but who can't necessarily negotiate for condom use.
I wish you a wonderful and a very happy New Year!
Editor in Chief